抗肿瘤血管生成,肿瘤免疫治疗与肿瘤微环境的研究进展

抗肿瘤血管生成已是临床上肿瘤治疗的常用方法.但是,在此治疗过程中,肿瘤也会逐渐对抗血管生成药物产生耐药,这可能与肿瘤微环境的改变有关.怎样进一步改善抗肿瘤血管生成治疗疗效是目前的热点问题.最近有研究认为将其与肿瘤免疫治疗相联合可能是一种相互增益的治疗策略.本文就抗肿瘤血管生成治疗及其耐药、肿瘤微环境与肿瘤免疫治疗的关系,抗肿瘤血管治疗联合肿瘤免疫治疗的最新进展,进行综述.以期为今后探索肿瘤治疗新靶点、寻找肿瘤治疗新模式提供思路及参考依据,从而最终造福于广大癌症患者.     

肿瘤微环境：抗血管治疗的重要靶点

自从20世纪70年代Folkman提出抗肿瘤血管生成治疗的学说以来,抗肿瘤血管治疗这一治疗模式已经历了30多年的发展历程。迄今国内外已近有40种以上的抗肿瘤血管药物在接受不同阶段的临床评价,其中以抑制促血管生成因子或相关受体的药物最多。     

抗血管生成疗法的新概念：血管结构正常化

肿瘤血管均表现为结构和功能异常,从而导致肿瘤血流分布异质性、间质高压、缺氧和酸中毒,对放、化疗的敏感性降低,侵袭性和转移能力增强.恢复血管生成因子和扩抗血管生成因子之间的平衡可以使血管结构工"正常化",从而使肿瘤间质压力降低、肿瘤氧供给增加、药物向肿瘤的渗透性增强.     

抗血管生成药物对肿瘤免疫调节影响的研究进展

恶性肿瘤的治疗已进入“精准治疗”时代,抗肿瘤血管生成的靶向治疗是近年非常热门的研究方向,而肿瘤免疫逃逸是导致肿瘤治疗效果不理想的重要原因之一。抗血管生成治疗不仅能够抑制血管生成,使肿瘤退缩,并且能够减少肿瘤微环境中免疫抑制性细胞数量,提高肿瘤浸润淋巴细胞（tumor-infiltrating lymphocyte ,TIL）、细胞毒性淋巴细胞（cytotoxic lymphocyte,CTL）等的数量,从而克服肿瘤免疫逃逸。本研究对抗血管生成药物通过改善肿瘤微环境,增强机体抗肿瘤免疫功能进行综述。      

血管正常化提高肿瘤治疗疗效

抗血管生成治疗作为肿瘤靶向治疗方式已得到临床广泛应用。抗血管生成治疗诱导的血管正常化效应机制,可以逆转肿瘤内部结构和功能异常的新生血管,改善肿瘤微环境的组织间隙高压、低氧和酸中毒,提高放化疗及免疫治疗的疗效。     

抗血管生成治疗影响肿瘤免疫治疗的研究进展

免疫治疗已经被证实是一一种有效的肿瘤治疗手段.但应答率一百不理想。研穿发现负疫治疗有多种影响因素，其中异常的肿瘤微环境会导致免疫抑制.减弱免疫治疗效果。抗血管生成治疗是一种通过拮抗促血管生成因子来调节肿瘤血管的治疗方式，可以改变肿瘤微环境进而加强自身的免疫刺激作用。临床上已证实抗血管生成治疗联合免疫治疗这一新型联合免疫治疗策略可以有效提高肿瘤治疗水平。本文就抗血 管生成治疗对免疫治疗影响的机制展开综述。     

抗血管生成药物联合免疫检查点抑制剂治疗恶性肿瘤的研究进展

[摘要] 肿瘤的生长需要血管的生成,不同于正常的血管,异常的肿瘤血管通过改变肿瘤微环境来抑制机体的免疫功能,从而使肿瘤发生免疫逃逸。抗血管生成治疗可以使肿瘤血管正常化,进而改善机体的免疫功能。免疫检查点抑制剂通过改变肿瘤微环境,不仅可以提高机体的免疫功能,同时也可以促进肿瘤血管的正常化。本文综述了抗血管生成治疗联合免疫检查点抑制剂治疗恶性肿瘤的理论依据以及相关的临床数据,为恶性肿瘤的治疗提供更多的治疗策略。     

晚期非小细胞肺癌EGFR-TKI耐药后抗血管生成联合免疫检查点抑制剂作用机制的研究进展

非小细胞肺癌（NSCLC）是肺癌中最常见的病理类型，表皮生长因子受体（EGFR）突变是NSCLC最常见的驱动基因突变。EGFR突变促进免疫抑制性肿瘤微环境（TME），但研究发现经表皮生长因子受体-酪氨酸激酶抑制剂（EGFR-TKI）治疗后TME发生改变，这种改变可能为优化随后的免疫检查点抑制剂（ICIs）治疗提供线索。临床前研究提示抗血管生成药物可以通过促进效应细胞浸润、减少免疫抑制等改善TME免疫抑制状态，增强ICIs疗效，ICIs也可促进血管正常化，两者具有协同抗肿瘤作用。EGFR-TKI耐药机制相对复杂，在缺乏特异性耐药机制患者中，单纯化疗或单纯ICIs获益有限，抗血管生成药物联合ICIs相关临床研究提示对于晚期EGFR-TKI耐药NSCLC患者可改善预后。全文就晚期EGFR突变NSCLC的TKI治疗对TME的影响、抗血管生成治疗联合ICIs的生物学原理、EGFR-TKI耐药后抗血管生成治疗联合ICIs相关临床研究等作一综述。     

肿瘤血管生成与抗血管生成基因治疗

肿瘤血管生成是肿瘤生长浸润转移的关键步骤，其形成主要是促血管生成因子和抑制因子作用失衡的结果。以肿瘤血管生成为靶点的抗血管生成治疗作为肿瘤治疗新视野，已发展为重要的抗肿瘤策略。基因治疗则使抗血管生成治疗更具有靶向性，使这一治疗策略产生新的飞跃。本文就该领域研究情况作一综述。     

血管生成抑制因子的研究进展

血管生成与肿瘤的生长、侵袭和转移密切相关,目前,以抑制血管生成为靶点治疗肿瘤有望成为抗肿瘤新疗法之一。近年来,研究发现了多种内源性血管生成抑制因子,其中一些已进入了临床试验阶段。本文对内源性血管生成抑制因子的结构、功能、作用机制及其在肿瘤治疗中的应用进行综述。     

Bacteria and cancer--antagonisms and benefits

There is considerable historical and recent evidence concerning the antagonisms between acute bacterial infections or their toxins and cancer and allied diseases. These data provide renewed incentives to undertake clinical programmes with mixed bacterial vaccines in many countries at the present time.     

Religiosity and physical and emotional functioning among African American and White colorectal and lung cancer patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

Genetic polymorphisms of alcohol and aldehyde dehydrogenases and risk for esophageal and head and neck cancers

Alcoholic beverages are causally related to cancer of the oral cavity, pharynx, larynx and esophagus. Ethanol is oxidized to acetaldehyde and then to acetate by alcohol dehydrogenase (ADH) and aldehyde dehydrogenase (ALDH), both of which have genetic polymorphisms. A review of case-control studies of the effects of ALDH2, ADH2 and ADH3 genotypes shows consistently positive associations between inactive heterozygous ALDH2 and the less-active ADH2 genotypes and the risk for esophageal cancer in East Asian heavy drinkers and this enzyme-related vulnerability may extend to light-to-moderate drinkers. Some studies suggest similar associations with the risk for head and neck cancer in moderate-to-heavy-drinking Japanese. An established carcinogen in experimental animals, acetaldehyde can interact with human DNA. ALDH2-associated cancer susceptibility fits into a scenario in which acetaldehyde plays a critical role in the development of human cancer. Alcohol flushing and drinking behavior may partly explain this carcinogenic effect in carriers of less-active ADH2 genotypes. Whether the ADH3 genotype influences head and neck cancer risk in Western nations is controversial. Professional and public education about risky conditions connected to the ALDH2 and ADH2 genotypes and environmental factors is important in a new strategic approach to the prevention of alcohol-related cancers in East Asians. The use of simple tests to identify inactive ALDH2 on the basis of alcohol flushing responses could benefit many people, by helping them to identify their own cancer risks. Such testing could also help clinicians diagnose esophageal cancer earlier, through the use of endoscopic screening in the high-risk population.     

Religiosity and Physical and Emotional Functioning Among African American and White Colorectal and Lung Cancer Patients

The literature suggests that religiosity helps cope with illness. The present study examined the role of religiosity in functioning among African Americans and Whites with a cancer diagnosis. Patients were recruited from an existing study and mailed a religiosity survey. Participants (N = 269; 36% African American, 56% women) completed the mail survey, and interview data from the larger cohort was utilized in the analysis. Multivariate analyses indicated that in the overall sample religious behaviors were marginally and positively associated with mental health and negatively with depressive symptoms. Among women, religious behaviors were positively associated with mental health and negatively with depressive symptoms. Religiosity was not a predictor of study outcomes for men. Among African Americans, religious behaviors were positively associated with mental health and vitality. Among Whites, religious behaviors were negatively associated with depressive symptoms. These findings suggest a mixed role of religious involvement in cancer outcomes. The current findings may have applied potential in the areas of emotional functioning and depression.     

Renal irradiation and the pharmacology and toxicity of methotrexate and cisplatinum

We used a rat model to study the effects of renal irradiation on the pharmacology of methotrexate (MTX) and cisplatinum (cis-Pt). Unanesthetized rats were given bilateral kidney irradiation (20 Gy in 9 fractions). At 9 months after irradiation, 3% of the animals had died and survivors showed moderately impaired renal function. At 15 months, 30% of the animals had died and survivors showed severely impaired renal function. Some animals were given i.v. MTX 1 week to 15 months after irradiation. In irradiated rats, the area under the MTX plasma clearance curve equaled that of controls through 6 months, and was significantly above controls from 9 months on. Other animals were given i.p. cis-Pt 1 week to 9 months after irradiation. The acute toxicity of cis-Pt was the same in control and irradiated rats when cis-Pt was given immediately before or after irradiation. Beginning 3 months after irradiation there was a progressive increase in cis-Pt toxicity and a simultaneous decrease in urinary platinum excretion. Irradiated animals that survived cis-Pt treatment showed increased radiation nephritis; the greatest effect occurred when cis-Pt was given 3 months or more after irradiation. MTX and cis-Pt clearance decreased when renal dysfunction was first observed and changes in renal function preceded changes in drug clearance and toxicity.